Hypertension 3 magawo, madigiri 3, chiopsezo 4: ndi chiyani?

Hypertension ndi matenda. Zomwe zaka makumi angapo zaposachedwa zakhala zikufalikira kwambiri m'magulu onse a anthu. Matendawa, chizindikiro chachikulu ndikuwonjezereka kwa kuthamanga kwa magazi chifukwa cha zifukwa zingapo.

Lipoti la World Health Organisation lati chipwirikiti chimachitika mwa munthu aliyense wokhala padziko lapansi.

Chifukwa chake, vuto lakudziwikitsa ndi kuchiza matendawa limadziwika. Izi zikugwira ntchito kwa aliyense, ndipo ngakhale zizindikilo zonse zimawonekera kwambiri mwa okalamba, koma pali zokhumudwitsa - matendawo oopsa ndi ochepa, amakhudza anthu omwe ali ndi zaka 30 kapenanso ochepera.

Nthawi zambiri anthu samalabadira kuwonekera kwakanthawi kwa kuthamanga mpaka atayamba matendawa mpaka magawo atatu, 3 ndi 4, motsatana. Ndi mayiko oyenda m'mphepete omwe ali oopsa kwambiri. Kodi matenda oopsa a grade 3 ndi kuti ndipo amachokera kuti?

Matenda oopsa komanso matenda oopsa

Dzina lasayansi la matendawa ndi ochepa matenda oopsa, ma analogu omwe atsalira ndi kusiyanasiyana komanso kugwirizanirana kwakale. Ili ndi mitundu iwiri.

Hypertension (mawu akuti chithandizo chofunikira kwambiri kapena matenda oopsa) ndiwowonjezereka komanso wopitiliza kuthamanga kwa magazi a genesis osadziwika.

Izi zikutanthauza kuti chomwe chimayambitsa chisokonezo sichikudziwika kwa sayansi, ndipo zonse zimangotengera zongoganiza.

Amakhulupirira kuti mu genome la munthu pali mitundu pafupifupi makumi awiri yomwe imakhudza kagwiridwe ka kayendedwe ka magazi. Matendawa amafalitsa oposa 90% ya milandu yonse. Chithandizo ndikuchotsa zoopsa ndikuchotsa zotsatilapo zake.

Sekondale, kapena chisonyezo choopsa cha matenda oopsa, chimachitika ndi matenda komanso kutsekeka kwa impso, endocrine tiziwalo tosakhazikika, kusungunuka kolowera mkati ndi kusayendetsedwa bwino pakati pa vasomotor pakati pa medulla oblongata, wopsinjika komanso wokhudzana ndi mankhwala, wotchedwanso iatrogenic.

Gawo lomaliza limaphatikizapo matenda oopsa oopsa omwe amayamba chifukwa chogwiritsa ntchito mankhwala a mahomoni panthawi ya kusintha kwa thupi kapena kulera.

Ndikofunikira kuthana ndi matenda oopsa motere, ndiye kuti, muthane ndi zomwe zimayambitsa, osati kungochepetsa mavuto.

Etiology ndi pathogenesis yakukula kwa matendawa

M'zaka zamakono opanga ma genetic, sizovuta kudziwa kuti chibadwidwe ndicho chimayambitsa kupanikizika kowonjezereka. Ndizotheka kwambiri kuti ngati makolo anu adandaula ndi kuchuluka kwamphamvu kwa kuthamanga kwa magazi, matendawo nawonso adzakupatsirani.

Chofunikanso kwambiri, koma osati pafupipafupi, ndizachilendo kwa okhala m'mizinda - maulendo ambiri opsinjika ndi kuthamanga kwa moyo. Zatsimikiziridwa mwasayansi kuti ndi kuchuluka kwambiri kwama psychoemotional, masango a neurons amagwa kunja kwa mabwalo azonse a neural, zomwe zimabweretsa kuphwanya lamulo lawo. Ubwino wotsatira malo ogwiritsira ntchito mphamvu umalumikizidwa ndi kuwonjezeka kwa kuthamanga kwa magazi.

Zowopsa zimawonetsa magulu amtundu wa anthu omwe ali ndi mwayi wocheza matenda oopsa.

Izi zikuphatikiza:

1. Anthu okalamba. Anthu ambiri amavomereza kuti munthu aliyense woposa 50 amakhala ndi matenda oopsa, ngakhale atakhala kuti alibe matendawa. Ichi ndi chifukwa cha kuchepa kwa kuthamanga kwa mitsempha yamagazi, chifukwa cha mphamvu yawo yolimba yolimbana ndi mphamvu yama contractions ya mtima. Komanso, ndi zaka, chiopsezo cha atherosulinosis ya ziwiya zazikulu zimawonjezeka, zomwe zimapangitsa kuti magazi azichepetsedwa komanso magazi omwe amatenga magazi (ngati mpweya wapamtunda) kudzera pabowo laling'ono mkati mwa shaft yopangidwa ndi mafuta.
2. Akazi. Kafukufuku akuwonetsa kuti atsikana ndi amayi ali pachiwopsezo chachikulu chotenga matenda owonjezera magazi kuposa abambo. Cholinga chake ndi chikhalidwe champhamvu chamafuta, chomwe chimawonjezeka panthawi yomwe ali ndi pakati, ndikuzimiririka modabwitsa pamene kusintha kwa thupi kumachitika. Ma estrogens opangidwa ndi thumba losunga mazira amachepetsa kuthamanga kwa magazi, koma amalamulira hafu yokha ya kusamba. Nthawi yawo yopanga ikamira, azimayi amayamba kuda nkhawa ndi zizindikiro za kuthamanga kwa magazi.
3. Kusavomerezeka. Ku gawo ili mutha kudziwa momwe zimasinthira zakudya zamchere kwambiri, zomwe zimathandizira kubwezeretsanso kwa madzi m'matumbo a nephron ndikuthandizira kuwonjezeka kwa magazi ozungulira, komanso kuchuluka kwa calcium. Iyo, monga ion yayikulu mtima, ndiyofunikira pakugwiritsa ntchito myocardium yonse. Kupanda kutero, arrhythmias ndi mkulu wa arterial ejection ndizotheka, zomwe zimabweretsa kuwonjezeka kwa mavuto.
4. Mowa ndi kusuta. Zizolowezi zovulaza zokha ndizovulaza kwambiri, zimawonongeranso zipolopolo zamkati ndi zotanuka zamagazi, zimapangitsa kuti azitha kutambalala mokwanira ndikugunda ndi kugunda kwamphamvu. Kuchepa kwapafupipafupi kwa mitsempha yamagazi chifukwa cha utsi wa chikonga ndi utsi wa ndudu kumayambitsa kuphwanya kwa mkati ndi mtima wamitsempha.

Kuphatikiza apo, chimodzi mwazinthu zomwe zimakhalapo ndikupezeka kuti kunenepa kwambiri komanso matenda a shuga. Kunenepa kwambiri kumalumikizana ndi kusachita masewera olimbitsa thupi. Hypertonic yotere imayendetsa njira yotsika ya moyo, zotengera zake, chifukwa chosowa katundu wambiri, zimataya minofu yawo ndipo sizimayenderana ndi kayendetsedwe kazinthu zamagetsi.

Kuphatikiza apo, mulingo wa atherogenic lipids ukuwonjezeka, womwe umadumphira endothelium yamitsempha yamagazi, ndikuwakhudza.

Dystrophy iyi imapangidwira kwambiri mu matenda a shuga, chifukwa chifukwa cha kukomoka kwa carbohydrate metabolic boiler, mafuta sakhala ndi okosijeni komanso osweka, sangatengeke ndi kuzungulira magazi.

Kukula kwa matenda oopsa komanso zotulukapo zake

Chipatalachi chimasiyanitsa magulu anayi othandizira matenda oopsa, omwe ali ndi njira yapadera yodziwira matenda, chithandizo

Kuphatikiza apo, pali magulu angapo owopsa chifukwa cha zovuta za matendawa

Magulu achiwopsezo amadalira kukhalapo kwa zinthu zina zomwe zimapangitsa kuti matendawa athe.

Gulu lotsatirali la ochepa matenda oopsa malinga ndi kuthamanga kwa magazi ndizotheka.

• Gawo 1 - systolic 140-159 / diastolic 90-99 mm RT. Art.
• Giredi 2 - systolic 160-179 / diastolic 100-109 mm RT. Art.
• Giredi 3 - systolic 180+ / diastolic 110+ mm RT. Art.
• Isolated systolic hypertension - systolic 140+ / diastolic 90.

Kuchokera pagawoli ndizodziwikiratu kuti owopsa kwambiri ndi digiri ya 3, yomwe imakhala ndi kupanikizika kwambiri, vuto lakale kwambiri. Digiriyo imatsimikiziridwa ndi muyeso wamba wakanthawi malinga ndi njira ya Korotkov, koma simakhala ndi zidziwitso zamankhwala. Kuti muwonetse kusintha kwa ziwalo zomwe zimakhudzidwa kwambiri ndi kuchuluka kwa magazi (zomwe zimatchedwa ziwalo zomwe zikulunjidwa) ndi zotulukapo zake, gulu lidapangidwa. Izi ziwalo monga ubongo, chiwindi, impso, mapapu. Zizindikiro zazikulu ndikutupa kwa chiwalo parenchyma ndikuphwanya kwa ntchito yake ndikukula kwa kusakwanira.

Gawo 1 - kusintha kwa ziwalo zomwe mukufuna sizikupezeka. Zotsatira zamankhwala oterewa zimachiritsa wodwalayo ndi njira yoyenera yolandirira.

Gawo lachiwiri - ngati chiwalo chimodzi chikukhudzidwa, wodwalayo ali mu gawo ili la matendawa. Pakadali pano, ndikofunikira kuyeserera kwa omwe akukhudzidwa ndikuyang'ana kwa katswiri. ECG, echocardiography, mayeso amtundu wa retinopathy mukamayang'ana fundus (chizindikiro chodziwikiratu komanso chodziwika bwino pakadali pano), kuyesa kwazonse komanso kwamphamvu ya magazi, urinalysis.

Gawo lachitatu - vuto lomwe limadutsa kumayambiriro kwa vuto la matenda oopsa. Amadziwika ndi kukhalapo kwa zotupa zingapo komanso zambiri zamankhwala opitilira chimodzi. Ikhoza kukhala: hemorrhagic and ischemic strips chifukwa cha angiopathy of the mtsempha wamagazi, encephalopathy ya magawo osiyanasiyana, matenda a mtima - Mavalidwe a Dressler, matenda obwezeretsanso komanso matenda a mtima. Izi zikutsatiridwa ndi kuwonongeka kwa chotchinga cha impso, chifukwa cha momwe proteinuria imachitikira, njira zosinthira ndi kusinthanso kwa plasma yamagazi mu nephron imakulirakulira, ndikulephera kwamphumo. Zombo zazikulu zimakhudzidwa ndi izi, zomwe ziwoneka ngati aortic aneurysm, atherosclerosis yayikulu, komanso kuwonongeka kwamitsempha yama coronary. Retina imakonda kwambiri kuthamanga kwa magazi, komwe kumawonetsedwa ndi kuwonongeka kwa mitsempha ya optic ndi hemorrhage ya intraocular. Gawo ili likufunika njira zowerengera kuti athe kulipira njira zowonongeka ndi mankhwala.

Gawo 4 - dziko lodwala, lomwe, ndikulimbikira kupitirira sabata limodzi, limabweretsa kulumala kosasintha.

Kuphatikiza apo, pali magulu angapo owopsa chifukwa chopanga zovuta:

1. woyamba - pa nthawi ya mayeso, palibe zovuta, ndipo kuthekera kwa kakulidwe kazaka zoposa 10 kuli mpaka 15%;
2. chachiwiri - pali zinthu zitatu, ndipo chiopsezo cha zovuta sizichulukirapo 20%;
3. chachitatu - kukhalapo kwa zinthu zopitilira zitatu zidawululidwa, chiopsezo cha zovuta ndi pafupifupi 30%;
4. wachinayi - kuwonongeka kwambiri kwa ziwalo ndi machitidwe kwapezeka, chiopsezo cha matenda a mtima ndi sitiroko ndi choposa 30%.

Kutengera ndi zomwe tafotokozazi, zikuwonekeratu kuti matenda oopsa a gawo lachitatu ali pachiwopsezo cha 4. M'mawu osavuta, matendawa ndi akupha.

Chithandizo cha matenda oopsa

Arterial hypertension grade 3 chiopsezo 4 imafuna chisamaliro chodzidzimutsa ndipo sichilekerera kuchedwa. Mavuto ndi osasangalatsa kwambiri - kugunda kwa mtima, sitiroko, kulephera kwaimpso.

Pofuna kuti musadikire vuto loti mukhale ndi matenda oopsa, muyenera kuyimba ambulansi posachedwa pomwe pali zizindikiro zazikulu zoopsa - kupanikizika kwa ma systolic pamtunda wa 170, kupweteka kwa mutu, mseru wapakati chifukwa cha kuthinikizidwa kwakukulu (mutatha kusanza, kugonthetsa kotereku sikuchepetsa vutolo), tinnitus chifukwa cha kuchuluka kwa magazi, kuwawa kumbuyo kwa sternum, kufooka miyendo ndi dzanzi.

Mwina kumverera kwa "goosebumps" pansi pa khungu, kuchepa kwamtsogolo kwa kukumbukira ndi kuchepa kwa luso la luntha, kuwona koperewera.

Mdziko lino, zochitika zolimbitsa thupi, kusuntha kwadzidzidzi kumatsutsana, odwala amaletsedwa kuchita maopaleshoni, kubereka, kuyendetsa galimoto.

Malangizo a akatswiri ndi ogwiritsa ntchito mankhwala osiyanasiyana, iliyonse yomwe ingakhudze gawo lake la unyolo wa pathogenesis.

Kukonzekera kwa gulu lalikulu, lomwe limagwiritsidwa ntchito makamaka pa matenda oopsa:

• Ma loop okodzetsa ndi zinthu zomwe zimalepheretsa khungu la Na + K + Cl -anscopter m'chigawo chakumtunda kwa Henle nephron loop, yomwe imachepetsa kubwezeretsanso kwamadzi, madzi samabwereranso kuthambo, koma amatulutsidwa kwambiri m'thupi. Kuchuluka kwa magazi ozungulira kumachepa, ndipo limodzi ndi magazi. Ndalamazi ndi monga Furosemide (aka Lasix), Indapamide (yemwenso amadziwika kuti Indap kapena Arifon), Hydrochlorothiazide. Amagwiritsidwa ntchito nthawi zambiri, chifukwa ndiotsika mtengo poyerekeza ndi analogues.
• Beta blockers. Kuchepetsa contractility yamtima kuchuluka ndi kalasi 3 matenda oopsa, kutsekereza adrenergic zotumphukira za myocardium. Mankhwala a gululi ndi monga Anaprilin (Propranolol), Atenolol (Atebene), Cordum, Metoprolol (pali mitundu ya Spesicor, Corvitol ndi Betalok), Nebivalol. M'pofunika kugwiritsa ntchito mankhwalawa momveka bwino mogwirizana ndi malangizo, chifukwa piritsi la blocker yowonjezera imatha kubweretsa kulowetsedwa komanso automatism ndi arrhythmias.
• Angiotensin-otembenuza enzyme zoletsa. Angiotensin imachulukitsa kuthamanga kwa magazi, ndipo ngati mungasokoneze kapangidwe kake m'matumbo a angiotensinogen, mutha kuchotsa mwachangu komanso moyenera zizindikiro za matenda oopsa a grade 3, ngakhale mutakhala ndi chiwopsezo cha 4. Oimira odziwika gululi ndi Captopril (Kapoten), Kaptopress, Enap (Renitek), Lisinopril. Kutseka kwa angiotensin receptors mwachindunji ndi Losartan ndikotheka.
• Omwe akutsutsana ndi calcium - Nifedipine ndi Amlodipine - amachepetsa mphamvu ya mtima komanso kuchuluka kwa magazi, potero amachepetsa kuthamanga kwa magazi.

Ndikotheka kupewa matenda oopsa komanso oopsa kwambiri kunyumba. Maziko a njirayi ndi chakudya chokhwima monga njira yayikulu yothandizira, makamaka kugwiritsa ntchito gome la mchere No. 10 malinga ndi Pevzner.

Mulinso mkate wa tirigu, nyama zamafuta ochepa, masaladi olemera kwambiri, mazira owiritsa, zakumwa mkaka wowawasa, sopo. Onetsetsani kuti muchepetsa mchere wambiri mpaka 6 g patsiku. Njira zina ndizovuta - valerian, mamawort, mint wa tsabola, hawthorn.

Gawo 3 matenda oopsa afotokozedwa mu kanema munkhaniyi.